KNOWLEDGE AND ACCEPTABILITY OF CERVICAL CANCER SCREENING AMONG FEMALE CIVIL SERVANTS

ABSTRACT

This research examined the Knowledge and acceptability of cervical cancer screening among female civil servants. The survey research was used in this study to sample the opinion of respondents. This method involved random selection of respondent who were administered with questionnaires. The target population of the study comprised selected nurses from hospitals in Ogun State, Nigeria. A total of 300 respondents were recruited as sample size for the present study. The descriptive and analytical approach was adopted using Chi-square to test and analyze the hypotheses earlier stated. Relevant conceptual, theoretical and empirical literature was reviewed.Findings revealed that there is a significant impact of knowledge of female civil servants on the utilization of cervical cancer screening services in Nigeria. The finding of the study also reveals that the knowledge of cervical cancer screening enables the female civil servant to seek for help anytime they fell symptoms of the issues. The findings of the study also reveal that. The finding of the study also reveals that cervical cancer screening is essential for early detection and prevention of cervical cancer. The findings of the study reveal that there is an impact of family function on the academic performance in Kano colleges. It was therefore concluded that there is a significant impact of knowledge of female civil servants on the utilization of cervical cancer screening services in Nigeria. It was recommended that nurses should be adequately trained in all aspects of cervical cancer service provision, including counselling.

 CHAPTER ONE

INTRODUCTION

1. Background of the Study

Cancer is a terrifying illness that does not care about a person's social standing. People who have cancer suffer from physical, emotional, and financial pain. Even a cancer patient's family members are not exempt from pain.The term "cancer" is used to refer to a set of disorders that are defined by abnormal and uncontrolled cell and tissue proliferation, which leads to the formation of tumors that infiltrate the body's normal cells and tissues.According to Qalawa et al. (2013), worldwide, cardiovascular illnesses are now the main cause of mortality, with cancer coming in second. Every year, more than 6 million people die from cancer and almost 10 million more are diagnosed with it.One type of cancer that affects the cervix, the lower portion of the uterus that enters into the vagina, is cervical cancer.

Non-communicable cervical cancer is a serious public health concern that affects women all over the world. WHO (2018) reported that 311,000 women died from the disease and 570,000 women received cervical cancer diagnoses globally in 2018.Human papillomaviruses (HPV) are linked to nearly 99% of occurrences of cervical cancer. It is a typical virus that is spread through sexual activity.According to WHO (2014), the majority of cervical cancer deaths—85.0%—occur in the world's poorest regions. Cervical cancer may be brought on by circumstances that are amenable to modification.The Human Papilloma Virus (HPV), the Hepatitis B virus, the helicobacter bacterium, ultraviolet radiation, physical inactivity, occupational exposures, food contaminants like aflatoxin, ionizing radiation, and early sexual activity are all risk factors, according to the World Health Organization (WHO) (2010).While age, ethnicity, heredity, sex, immune suppression, and reproduction are among the non-modifiable risk factors. Simply put, this indicates that modifiable risk factors can be avoided (Nnodu et al., 2010).

The goal of cervical cancer screening is to identify alterations in cervix cells that may develop into cancer. Women should undergo frequent cervical cancer screening, which involves cervical cytology (commonly known as the Pap test or Pap smear) and testing for the human papilloma virus (HPV). Cancer develops when cervical cells undergo alterations, turn aberrant, and eventually proliferate uncontrollably.The cervical tissue is further penetrated by the cancer cells. High-grade alterations in cervical cells typically take 3 to 7 years to develop into cancer. In severe situations, cancer cells have the potential to spread to other bodily organs. Cervical cancer screening makes it possible to find these alterations before they progress to malignancy.Women who have mild abnormalities can get more frequent testing to determine whether their cells return to normal. Women who have advanced alterations may have therapy to have the cells removed.

          Screening for cervical cancer saves lives. It contributes to a decrease in cervical cancer cases and female fatalities from the disease. The Pap test, an HPV test, or both are used for cervical cancer screening. To check for cervical cancer, both procedures employ cells extracted from the cervix.Women should be encouraged to have routine cervical cancer screenings because they are a crucial component of their health(WHO, 2017).A person's attitude is a manifestation of both positive and negative circumstances, people, places, and things. Our views of our environment and how we behave in response to it are largely influenced by our attitudes. The attitude of women toward cervical cancer is crucial since it will influence how seriously they take it and how little they do. A person may have a favorable, negative, or neutral attitude.Since these are issues that are socially and culturally regarded as private and cannot be openly discussed in public, Lewis (2004) found that cervical cancer, a condition that affects women's sexual and reproductive health, was likely to be shrouded in silence.

          The same authorities also stated that women with negative attitudes toward cervical cancer because most of them feel that they are not susceptible to the disease, especially when they do not have symptoms of the disease, tend not to use cervical cancer screening services. Mengesha et al. (2020) stated that most women who are likely to have positive attitudes towards cervical cancer tend to utilize cervical cancer screening services regardless of their age.

In spite of their knowledge and awareness of cervical cancer, most women of all ages have a negative attitude toward it and do not use services for cervical cancer screening. Some of these women think that cervical cancer only affects older women who have finished having children, while others believe that they are immune to the disease.Screening for cervical cancer was therefore not necessary. According to the American Cancer Society, most women who are terrified of cervical cancer don't know enough about the disease.It was discovered that the majority of uneducated women with negative attitudes toward cervical cancer lacked sufficient knowledge on cervical cancer causes, risk factors, and screening options.According to Byrd and Tarwalte (2012), women with negative attitudes are less likely to use cervical cancer screening services because they have a greater dread of the disease because they believe that it cannot be cured. In certain cases, this anxiety is linked to fatalism.

          According to Hyacinth et al. (2012), women who have a negative attitude toward cervical cancer and who don't use services for screening don't have enough knowledge and awareness of the disease.In the same vein as Ivtekin (2013) and William and Amoateny (2012), these researchers suggested that women's lack of awareness about cervical cancer leads to their attitudes toward the disease and their use of cervical cancer screening.According to Nnode et al. (2010), women who are more informed about cervical cancer have a more favorable attitude toward the disease and use of screening services. These women are also more informed about other health issues, such as the disease itself.The same authority also found that older women had a negative attitude on cervical cancer, which may be because they don't think they're at danger for getting the disease.

Asobayire and Barley (2014) also pointed out that people with low knowledge frequently have a negative attitude toward cervical cancer because they find it difficult to access health information. Social stigma may also be a contributing factor in people's negative attitudes, as most women see cervical cancer as the result of bad deeds, according to Asobayire and Barley.The majority of women who had bad attitudes about cervical cancer thought that those who had it would be mistaken for witches(Asobayire and Barley (2014).

Narayara et al. (2017) found that the majority of women who expressed a favorable attitude toward cervical cancer screening services were aware of the disease's symptoms and risk factors.The same body also said that HPV vaccination and early screening are helpful in preventing cervical cancer. Due to obstacles including fear of vaginal examination, cervical screening, and a positive cervical cancer diagnosis, providing screening chances to women may not be fully exploited.According to Lim and Ojo (2017), ongoing cervical cancer awareness campaigns will influence how women feel about the disease and how often they use services for cervical cancer screening.According to Aweke et al. (2017), women with a favorable attitude toward cervical cancer believed that the disease may cause mortality if women were not checked and treated at the earliest opportunity.The same authority also stated that women who had a positive outlook believed that cervical cancer might be managed by using services for screening.

          In a study by Mengesha et al. (2020) to gauge women's attitudes, it was found that 370 (73.9%) and 366 (73.1%) of the 501 women who had heard of cervical cancer believed that having several sexual partners and getting married young were risk factors for the disease, respectively. The same authority went on to say that this may be due to the widespread misconception that engaging in any risky sexual practice puts one at risk for cervical cancer.Because the majority of respondents think that God always punishes persons who have several sexual partners for their misdeeds. Similar to this, 442 (88.2%) respondents thought cervical cancer was a significant health issue for women in the reproductive age group. The idea that cancer is a major health issue may just be a misconception. The study also revealed that 448 participants, or 58.2%, had a favorable attitude about cervical cancer. And this may then result in the use of services for cervical cancer screening.

According to Al-Meer et al. (2011), women who have a negative attitude regarding cervical cancer are less likely to use services for cervical screening. According to Shrestha et al. (2013), despite the low-level screening services, their attitude toward cervical cancer and use of those services is encouraging. This indicates that having a positive attitude toward cervical cancer may encourage use of those services.According to a study by Hinsermu et al. (2015) among nurses in Mekelle, those who have a positive attitude are 3.4 times more likely to get screened for cervical cancer than those who have a negative attitude.According to Gebreegziabher et al. (2014), respondents with negative views about screening had odds of being screened that were 63% lower than those with good attitudes.

          Despite the numerous empirical findings on the attitude of women towards the screening of cervical cancer, there is a dearth on the acceptability and knowledge of cervical cancer screening among female, hence the present study.

Statement of the Problem

The main gynecological health issue that has been on the rise and is still one of the leading causes of death is cervical cancer. Cervical cancer is one of the worst diseases that might occur. Cervical cancer has increased over time, especially in underdeveloped countries(Onobumeh et al., 2022). The various screening and treatment options for cervical cancer include, but are not limited to, naked eye examinations with or without acetate, liquid-based cytology, conventional cytology, human papillomavirus (HPV) DNA testing, and visual inspection.Cervical cancer is still the fourth highest cause of death for women worldwide, and uniformed women in Benin's capital city are not spared from this fact despite the avenues for screening tests that are currently available. The failure to use all of the aforementioned screening pathways may be to blame for the disease's meteoric increase.

However, despite the initiatives put in place by governments and international organizations to create knowledge, a positive attitude toward cervical cancer, and to encourage the utilization of cervical cancer screening services among women globally, the non-utilization of the screening services may be due to a poor attitude, fear, anxiety, and the lack of screening centers in rural areas and very few in urban centers.Little is known as whether uniformed women in Nigeria are well informed in terms of knowledge of the disease, acceptability, its awareness and more so, if they show positive attitude towards the disease and moreover if the cervical cancer screening services are well or adequately utilized. It is based on this background that the present study seeks to examine the Knowledge and acceptability of cervical cancer screening among female civil servants.

Objectives of the Study

The main objective of this study is to examine the Knowledge and acceptability of cervical cancer screening among female civil servants. Other objectives of the study include;

1. To determine the impact of knowledge of female civil servants on the utilization of cervical cancer screening services in Nigeria
2. To ascertain the impact of acceptability of female civil servants on the utilization of cervical cancer screening servicesin Nigeria
3. To determine the attitude of female civil servants on the utilization of cervical cancer screening services in Nigeria
4. To examine the significance relationship between Knowledge and utilization of cervical cancer screening services in Nigeria.

Research Questions

The following questions were formed to give direction to the present study;

1. Does knowledge of female civil servants have impact on the utilization of cervical cancer screening services in Nigeria?
2. Does acceptability of female civil servants have impact on the utilization of cervical cancer screening services in Nigeria?
3. Does the attitude of female civil servants have impact on the utilization of cervical cancer screening services in Nigeria?
4. Is there a significance relationship between Knowledge and utilization of cervical cancer screening services in Nigeria?

Research Hypotheses

The following were hypothesized;

Hypothesis One

H0: There is no significant impact of knowledge of female civil servants on the utilization of cervical cancer screening services in Nigeria

H1: There is a significant impact of knowledge of female civil servants on the utilization of cervical cancer screening services in Nigeria

Hypothesis Two

H0: There is no significant impact of acceptability of female civil servants on the utilization of cervical cancer screening services in Nigeria

H1: There is a significant impact of acceptability of female civil servants on the utilization of cervical cancer screening services in Nigeria.

Hypothesis Three

H0: There is no significant impact of attitude of female civil servants on the utilization of cervical cancer screening services in Nigeria

H1: There is a significant impact of attitude of female civil servants on the utilization of cervical cancer screening services in Nigeria

Hypothesis Four

H0: There is no significant relationship betweenKnowledge and utilization of cervical cancer screening services in Nigeria

H1: There is a significant relationship between Knowledge and utilization of cervical cancer screening services in Nigeria

1. Significance of the Study

The significance of this study is to examine Knowledge and acceptability of cervical cancer screening among female civil servants.

The findings of this study will benefit women because it may raise their awareness and knowledge of cervical cancer screening and reduces cervical cancer-related illness. There will be a reduction in advanced cervical cancer and mortality, as well as an improvement in women’s quality of life.

The findings of this study will also raise awareness about the need of cervical cancer screening and to prevent subsequent complications. Cervical cancer can be detected early. It would depict how women’s awareness and attitudes toward cervical cancer screening differ depending on their social, educational, and cultural status. This is a first step in raising awareness among women in the sub city and at the health office and demonstrates the state’s difficulties in reducing the number of cervical cancer cases.

This study will also contribute immensely to the body of knowledge in health education and practices at the hospitals in Nigeria, and would be used by policy makers in Nigeria to develop guidelines and programmes to improve health education and cervical cancer screening practices.

1. Delimitation/Scope of the Study

This study is limited to the Knowledge and acceptability of cervical cancer screening among female civil servants in Nigeria with Ogun State as a case study. This study will be conducted in four hospitals in Ogun State. The participants for this study will be restricted to only nurses in the selected hospitals.

1. Operational Definition of Terms

Cervix

The cervix is the lower part or neck of the uterus between isthmus and the opening of the uterus into the vagina (Harvey, 2005).

Cervical cancer

Cervical cancer is defined as cancer of the cervix that develops from premalignant lesions.

Cervical cancer screening

          Cervical cancer screening is considered in the study as a method of detecting premalignant lesions on the cervix in order to prevent cervical cancer in women aged 18to 49 years in the Nigeria. Methods of detection include pap smear cytology, liquid based cytology, the HPV DNA test, and ocular inspection with acetic acid.

Knowledge

It refers to familiarity, awareness, or understanding of someone or a certain aspect. This comprises facts, information, descriptions, or abilities gained through experience or study as a result of observing, finding, or learning. The study focuses on women’s perceptions about cervical cancer and screening procedures a s well as the resources available in their health centres in relation to their social status, educational level (primary, secondary, or higher education level), and economic status in Nigeria.

Attitude

 It is a favorable or unfavorable expression towards a person, place, item, or event, or a way of behaving that is influenced by those circumstances (Cambridge English dictionary, 2016). In this study, attitude refers to women’s attitudes concerning cervical cancer and screening procedures. This refers to their socioeconomic status, education levels, and economic hierarchy within the Nigeria.

Acceptability

          Acceptability is the characteristic of a thing being subject to acceptance for some purpose. For this study, acceptability means the ability of the respondents to agree to participant in cervical cancer screening.